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Home My Public Portal About9830 FLAHERTY ST_Mechanical__ ION DECLARAT WORKER'S have a certificate of consent to 76A346DPW9,69 APPLICATION FOR PERMIT LIME GREEN 76A364C I hereby'pffirnt that'] have a certificate of consent to self insure, or`a certi w.te of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof•(Sec.3800 Lab.C.) � cy No. ` Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. Ely 9 p Certified copy is filed with the count buildin Ins ection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) ADDRESS641�ry 5T Date ApplicantLOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS COMPENSATION INSURANCE . ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption, you should become subject to the Workers' Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such 10, FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU V GRAVITY— LICENSED RAVITY LICENSED CONTRACTORS DECLARATION IfFLOOR BTU �r% VALI ATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATERSUSPENDED UNIT : (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. e License Number Lic.Class T a. Contractor Date a.U ❑ I am exempt under Sec. Plan Check fee B.&P.C.for this reason PERMIT ISSUINGFEE$ Date: TOTAL FEE ,�' �� LU d Signature C0 OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z I hereby affirm that I am exempt from the Contractor's License Law NAME , for th following reason (Section 7031.5, Business and Professions Ca Cod ADDRESS ?D Tk C% ;�+_•t_I tl s I, as owner of the property, or my employees with wages J �7 as their sole compensation, will do the work and the CITY � TEL. r1Sr10 N0& ,-i 6_ structure is not intended or offered for sale (Section'7044, l O0' O6 Business and Professions Code). OWNER �/ i :iL41 ❑ I, as owner of the property, am exclusively contracting MAIL �/V (i f i ill i 001 '- with licensed contractors to construct the project (Sec- ADDRESS 3 I-,fy6&T S-T -;-+ -- tion 7044, Business and Professions Code). `' t'I' °` 'iI CONSTRUCTION'LENDING AGENCY CITY T TEL.Ne?/e y¢� t-.'` 1,3 ';_I I hereby affirm that there is a construction lending agency for CONTRACTOR �Ca�� uv the performance of the work for which this permit Is issued , (Sec.3097, Civ. C.). ClADDRESS 1111C0—Cl 010 tr i Lender's Name 1. Til !-5-1 CITY TEL.NO. - i�? } 10 r• t I- Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIG . URE OF AP.VCAN74QR AGENIT DATE ION DECLARAT WORKER'S that'lhave a certificate of consent to 76A346DPW9,69. APPLICATION FOR PERMIT LIME GREEN 76A364C I hereby,,afil;m that'I have a certificate of consent to self insure, ora certificate of'Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy therevi•(,Sec.3800 Lab. C.) Policy No. JCompany COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILREDING n/ �/„ S department. (PRINT OR TYPE ONLY) ADDSS 3 0 LfT Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed it the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. COMPRESSOR,BTU Date Applicant VENTILATION SYSTEM APPROVALS DATE INSPECTOR'S SIGNATURE . NOTICE TO APPLICANT: If, after making this Certificate of ROUGH s. Exemption,you should become subject to the Workers' Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL S provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VA1( ATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. B� License Number Lic.Class IL Contractor Date , 0 ❑ I am exempt under Sec. Plan Check feeir BAP.C.for this reason PERMIT ISSUING FEE$ 34-0 Date: TOTAL FEE a d Signature U) PLAN CHECK APPLICANT- OWNER-BUILDER DECLARATION Z I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions CodL�Q r/JQ1 // /p?��Tzv r)' ADDRESS / Z!AR ! S _ �.•'-• ' �I, as owner of the property, or my employees with wages �_•;.-€e as their sole compensation, will do the work and the CITY /y TEL. _ structure is not intended or offered for sale (Section 7044, ^` eir �� L 3w;�f nl_jl_ Business and Professions Code). OWNER F] = 4�1i I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESSEZA I I I.HL 25 0_0 tion 7044, Business and Professions Code). _ CONSTRUCTION LENDING AGENCY CITY />> EL.NO e,2 J E f'K ti I hereby affirm that there is a construction lending a enc for. " " the performance of the work for which this permit 9s issued CONTRACTOR , t:i�ha, ,ia (Sec.3097,Civ.C.). ADDRESS Lender's NameI; c ^,.�ti-,e CITY TEL.NO. i 'Lender's Address STATE LIC. r t if t t I w 1 certify that I have read this application and state that the above LICENSE NO. CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a2014 SIG URE OP PLI T ORA NT ATE